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Pregnant women with MS may have done the larger MS community a big favor, simply by feeling pretty good. Noting how exacerbations are rare during the last two trimesters, MS researchers, notably UCLA's Rhonda Voskuhl, MD, wondered what caused the protective effect of pregnancy.
Dr. Voskuhl's team focused on estriol, a form of the hormone estrogen that rises to high levels during pregnancy. Estriol is known to alter the immune system. "There's a natural shift," Dr. Voskuhl explained, "so the mother's immune system won't reject the 'foreign' baby. This shift also means the immune system is not as likely to attack the mother's central nervous system."
In a pilot study funded by the National MS Society, Dr. Voskuhl gave six months of estriol-which can be taken orally-to 12 non-pregnant women, half with relapsing-remitting and half with secondary-progressive MS. The trial had a "crossover" design, so all 12 received the treatment. MRI images revealed a striking 80% drop in inflammatory lesions in the six women with relapsing-remitting MS while they were on the active treatment. "This is within the realm of the beta interferon and glatiramer acetate drugs," said Dr. Voskuhl. Inflammatory protein levels also went down. The six women with secondary-progressive MS did not improve significantly.
Dr. Voskuhl plans a longer trial for 70 women, starting this summer. If the results confirm estriol's benefit on MRI results and immune responses, then researchers will conduct still larger studies for three to five years. Only longer studies can establish whether estriol can also reduce relapse rates and whether or not it is safe for long-term use. If it proves both effective and safe, it would be an oral treatment for MS.
That delivery method is crucial. "The beauty of this is that it's not given as a shot. It's a pill a day," Dr. Voskuhl said. A pill could be more readily accepted by more patients, more quickly-meaning more would begin treatment right after diagnosis. "Ultimately, earlier treatment would be expected to lead to less disability," Dr. Voskuhl said.
|Last updated May 2006|